Core Competencies in Hospital Medicine

The Core Competencies in Hospital Medicine: A Framework for Curriculum Development published in the January / February 2006 supplement of the Journal of Hospital Medicine, is a blueprint to develop standardized curricula for teaching hospital medicine in medical school, post-graduate (i.e., residency, fellowship) and continuing medical education programs.
The competencies standardize expected learning outcomes, enable curriculum developers and content experts to select instructional strategies, provide relevancy of context, and select the most relevant and current medical content.

The publication contains 51 chapters, divided into three sections:

Clinical conditions

Procedures

Healthcare systems

Each chapter contains an introduction followed by learning objectives categorized into knowledge, skills or attitudes. Some chapters include a fourth section entitled "system improvement" that lists specific activities of a hospitalist to improve the system of care. Statements in this fourth section allow for a range of expectations and proficiencies.

The Society of Hospital Medicine (SHM) uses the core competencies to drive education programs. The Society of Hospital Medicine regularly engages in analysis to identify gaps in the educational efforts relative to the core competencies with a focus on healthcare system topics such as quality improvement, transitions of care, patient education, palliative care and information management.

Educational modalities are constantly being explored including podcasts, webinars, conferences, e-learning modules and physician preferences for the modalities analyzed.

Who should use the core competencies?

Educators may use core competencies to revise and/or develop curricula and assess their current programs. Review of these competencies by the larger medical community will lead to educational reform that better prepares physicians to become hospitalists.

The core competencies were developed with the following audiences in mind:

Directors of continuing medical education (CME)

Hospitalist fellowship directors

Residency program directors

Medical school internal medicine clerkship directors

Hospital administrators and leaders

The core competencies offer residency program directors an opportunity to help meet the goals outlined by the Accreditation Council for Graduate Medical Education (ACGME).

The core competencies address all six of the ACGME competencies including:

Interpersonal Skills and Communication

Medical knowledge

Systems Based practice

Practice Based Learning and Improvement

Patient Care

Professionalism

By incorporating the core competencies in hospital medicine into residency curricula, a program director can meet the ACGME requirements and teach resident physicians many of the issues that often fall outside traditional medical curricula.
The core competencies should provide the framework of professional development for and evaluation of hospitalists. Any hospitalist-specific CME should be developed around the core competencies.

For example, a program on community-acquired pneumonia (CAP) should focus on the common etiologic agents of CAP as well as how hospitalists can assist in ensuring hospital-wide adherence to The Joint Commission standards. Similarly, if one is leading a hospitalist program, the core competencies can provide the common language for evaluation of physicians in that program.

What methodology was used to develop the core competencies?

A task force representing academic and community hospitalists from varying regions within the United States was formed following SHM's Education Summit in 2002. The task force developed an initial table of contents and structure for the core competencies that were vetted through SHM's various regional chapters and councils, as well as the Education Committee and Executive Committee.

Contributors were selected based on a nomination and panel review process. When appropriate, authors were paired with non-hospitalist experts. Once submitted, chapters underwent an extensive editing process for accuracy, level of detail, formatting and adherence to established educational principles. The final document underwent internal and external review. Once all review comments were received, the task force editorial board reviewed each comment and made changes to the competencies when necessary.

Who contributed to the development of the core competencies?

The core competencies are a result of the contributions of more than 100 hospitalists and other content experts, under the guidance and leadership of the SHM Core Curriculum Task Force and Editorial Board.

Task force members were chosen from university and community hospitals, teaching and non-teaching programs, for- and not-for-profit programs, and from all geographic regions of the United States to ensure broad representation of practicing hospitalists and SHM membership.

The editors are:

Michael Pistoria, DO

Alpesh Amin, MD, MBA

Daniel Dressler, MD, MSc

Sylvia McKean, MD

Tina Budnitz, MPH

How are the core competencies different from other competency guidelines?

The core competencies integrate the six competencies of ACGME into the four sections of each chapter.

Besides the traditional knowledge (cognitive domain), skills (affective domain), attitudes (psychomotor domain) sections, a fourth section on systems-based practice was included to highlight the role of hospitalists in improving the hospital systems in which they work.

Other published competencies often use vague terms like "understand" that give little or no insight into the level of proficiency that is expected. The core competencies are carefully crafted to place the concept at the correct level of proficiency.

Why aren't all clinical conditions addressed?

The core competencies in hospital medicine are meant to guide educators to develop curricula that incorporate the competencies into the training and evaluation of students, clinicians-in-training and practicing hospitalists. It is not meant to contain a complete compilation of all inpatient clinical topics or recreate what many residency training programs in adult inpatient care already provide. It should not limit and does not define every aspect of hospitalist practice. It includes the most common and fundamental elements of inpatient care without an exhaustive listing of every clinical entity that may be encountered by a hospitalist. Some of the more common clinical topics encountered by inpatient physicians are included, with an emphasis on subject areas that stress the systems-based approach to healthcare, which is central to the practice of hospital medicine. The core competencies also focus on potential areas that could enhance the training of physicians to reflect the current practice of hospitalists.

What about core competencies in pediatric hospital medicine?

What changes can be expected in future editions?

The Society of Hospital Medicine will evaluate feedback from residency directors, curriculum developers and other medical educators and practicing hospitalists to determine how future editions of the core competencies can best meet the needs of its audience. A thorough review of current chapters and potential additions are currently in process.